2013-11-07T08:04:26-06:00 2012-12-31 221478099 COHNREZNICK LLP 1212 6TH AVENUE NEW YORK NY 10036 990 2012-01-01 141628237 HUDSON HEADWATERS HEALTH NETWORK INC HUDS 5187610300 9 CAREY ROAD QUEENSBURY NY 12804 DR JOHN RUGGE 5187610300 2013-11-04 1 THOMAS LANNING P00851654 2122970400 2012 2016-02-25 16:41:14Z DR JOHN RUGGE 9 CAREY ROAD QUEENSBURY NY 12804 54300383 0 X WWW.HHHN.ORG X 1981 NY FQHC - OUR MISSION IS TO PROVIDE THE BEST HEALTH CARE AND ACCESS TO THAT CARE FOR EVERYONE IN OUR COMMUNITIES. 17 17 704 0 1009416 0 12066041 7548405 35290892 45267011 17165 13512 1533769 1471455 48907867 54300383 0 791809 0 0 28496050 33708583 0 0 0 16555814 16776057 45051864 51276449 3856003 3023934 25872941 27101441 12396058 10600624 13476883 16500817 X WE ARE A COMMUNITY BASED HEALTH CLINIC WHICH SERVICED 281,390 PATIENTS IN 2012. TO FURTHER THE PROVISION OF COMPREHENSIVE HEALTH CARE SERVICES TO THE GENERAL POPULATION OF WARREN, WASHINGTON, SARATOGA, HAMILTON AND ESSEX COUNTIES. TO PROMOTE, SPONSOR, FOSTER AND DELIVER PROGRAMS, ACTIVITIES AND SERVICES WHICH SHALL HAVE THE PURPOSE OF IMPROVING THE HEALTH AND WELL-BEING OF THE POPULATION SERVED BY THIS CORPORATION AND TO CONTINUALLY SEEK NEW AND INNOVATIVE METHODS OF IMPROVING HEALTH CARE DELIVERY AND ITS FINANCING TO THE COMMUNITY SERVED. TO CARRY OUT ANY EDUCATION AND TEACHING ACTIVITIES RELATED TO RENDERING HEALTH CARE OR TO THE PROMOTION OF HEALTH THAT IN THE OPINION OF THE BOARD OF DIRECTORS MAY BE JUSTIFIED BY THE FACILITIES, PERSONNEL, FUNDS OR OTHER RESOURCES THAT ARE FOR, OR CAN BE, MADE 0 0 42031523 791809 45531448 THE CENTER IS A COMMUNITY BASED HEALTH CLINIC WITH MULTIPLE LOCATIONS.IN 2012 WE SERVICED 281,390 PATIENT VISITS. 3827190 340B PHARMACY PROGRAM - AS A FEDERALLY QUALIFIED HEALTH CENTER WE ARE ABLE TO ACQUIRE DRUGS AS THE LOWER PRICES MANDATED BY THE FEDERAL 340B DRUG PURCHASING PROGRAM, THIS ALLOWS US TO ASSIST INDIGENT PATIENTS WITH THE SOMETIME OVERWHELMING COSTS OF PRESCRIPTION MEDICATIONS, FACILITATE THE HUDSON HEADWATERS HEALTH NETWORK PATIENT ASSISTANCE PROGRAM WHICH ENABLES NEEDY PATIENTS TO RECEIVE MEDICATIONS FREE OF CHARGE FROM THE DRUG MANUFACTURERS, AND GENERATE REVENUE TO SUPPORT HHHN'S OVERALL OPERATIONAL VIABILITY. 45858713 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 74 0 1 704 1 1 1 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X AMY GERSTEN 5187610300 9 CAREY ROAD QUEENSBURY NY 12804 BARBARA ORTON 1.00 X 0 0 0 BARBARA SWEET 1.00 X 0 0 0 DANA HOGAN 1.00 X 0 0 0 EILEEN HAYNES 1.00 X 0 0 0 EUGENE ARSENAULT 1.00 X 0 0 0 GRAHAM GREELEY 1.00 X X 0 0 0 HARRY ROBINSON 1.00 X 0 0 0 IKE WOLGIN 1.00 X 0 0 0 JEAN CRONIN 1.00 X 0 0 0 JOSEPH KELLY 1.00 X X 0 0 0 MICHAEL MCCARTHY 1.00 X 0 0 0 MILDRED ANZALONE 1.00 X 0 0 0 PATRICIA HARRISON 1.00 X 0 0 0 PATRICIA HUNT 1.00 X 0 0 0 PAUL D RICE ED 1.00 X 0 0 0 RANDOLPH RAPPLE 1.00 X 0 0 0 SHARON CALLAHAN 1.00 X X 0 0 0 THERESA TREADWAY LLOYD 1.00 X 0 0 0 THOMAS GOODROW 1.00 X 0 0 0 THOMAS LYONS 1.00 X 0 0 0 THOMAS ROSS 1.00 X X 0 0 0 WILLIAM O'DWYER 1.00 X X 0 0 0 CHRISTOPHER TOURNIER 40.00 X 174268 0 24415 CYNTHIA REYNOLDS 40.00 X 119338 0 22031 DANIEL LARSON MD 40.00 X 216128 0 29537 DEBORAH BARDIN 40.00 X 117343 0 14475 EDWARD SHANNON 40.00 X 181306 0 28661 GEORGE PURDUE 40.00 X 227652 0 28644 JOHN RUGGE 40.00 X 484900 0 34268 JOHN SAWYER 40.00 X 223090 0 29109 LORI GRAVELLE 40.00 X 63957 0 15105 MARLENE BURNLEY 40.00 X 98727 0 19005 PAUL BACHMAN 40.00 X 212547 0 28766 BRIAN MCDERMOTT 40.00 X 313844 0 13898 DANIEL WAY 40.00 X 208930 0 26963 MICHAEL ADAMS 40.00 X 203458 0 27320 TODD WALDORF 40.00 X 237385 0 29904 WILLIAM BORGOS 40.00 X 210878 0 28366 3293751 0 400467 14 0 1 0 RICHARD E JONES ASSOCIATES 339 AVIATION RD QUEENSBURY NY 12804 ARCHIECTURAL SERVICES 335492 GLENS FALLS OBGYN 28 S WESTERN AVE GLENS FALLS NY 12801 MEDICAL SERVICES 150057 COHNREZNICK LLP 1212 AVENUE OF AMERICAS NEW YORK NY 10036 ACCOUNTING SERVICES 142351 FRANCIS AND EILLEN COLLINS PO BOX 64 GLENS FALLS NY 12801 RENT 125960 4 54951 5581773 1911681 7548405 OTHER THIRD-PARTY PAYORS 621400 22224685 22224685 MEDICARE 621400 8346145 8346145 SELF-PAY 621400 5817216 5817216 MEDICAID MANAGED CARE 621400 3027765 3027765 MEDICAID 621400 3022442 3022442 2828758 2828758 45267011 13512 13512 194944 0 194944 194944 111657 83287 403B CONSULTING 541610 897759 897759 MEANINGFUL USE 621400 264437 264437 ESCIBE REVENUE 621400 67269 67269 47046 47046 1276511 54300383 45645763 1009416 96799 791809 791809 2393273 2152751 240522 25200476 22667848 2532628 847860 762651 85209 3314929 2981783 333146 1952045 1755867 196178 96702 96702 71694 71694 59592 59592 4441019 4398631 42388 145709 117942 27767 1231854 939500 292354 547503 481350 66153 862578 711118 151460 285169 205349 79820 84720 61006 23714 216448 50662 165786 1463088 1205366 257722 200523 91849 108674 MEDICAL SUPPLIES 3768142 3457037 311105 PROVISION FOR BAD DEBT 1981243 1981243 REPAIRS AND MAINTENANCE 573807 476503 97304 DUES AND SUBSCRIPTIONS 272964 177667 95297 473302 390781 82521 51276449 45858713 5417736 0 459224 584527 2501471 1228674 945866 1265698 4873228 6650080 350000 350000 1494894 941026 21175710 6890972 13957468 14284738 300000 1290790 1496698 25872941 27101441 5299050 5585751 4415180 2414025 2681828 2600848 12396058 10600624 X 13476883 16500817 13476883 16500817 25872941 27101441 3023934 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1809928 1809928 9844669 1479295 8365374 3869590 1807985 2061605 2473923 1574770 899153 3177600 2028922 1148678 14284738 DEFERRED COMPENSATION ASSET 1496698 1496698 DEFERRED COMPENSATION PAYABLE 1496698 DUE TO NEW YORK STATE DEPARTMENT OF HEALTH MEDICAID 1104150 2600848 X 53053090 371029 -1618322 -1247293 54300383 0 54300383 49852277 371029 186042 557071 49295206 1981243 1981243 51276449 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE COMPANY IS INCORPORATED AS NOT-FOR-PROFIT CORPORATIONS UNDER THE LAWS OF THE STATE OF NEW YORK AND ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AS WELL AS FROM STATE INCOME TAXES. THEREFORE, THERE IS NO PROVISION FOR INCOME TAXES. THE COMPANY HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2012. THE COMPANY'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL YEAR 2009 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. PART XI, LINE 2D - OTHER ADJUSTMENTS: RELATED PARTIES REVENUE 431,132. INTERCOMPANY ELIMINATION -68,211. BAD DEBT EXPENSE -1,981,243. PART XII, LINE 2D - OTHER ADJUSTMENTS: RELATED PARTIES EXPENSES 254,253. INTERCOMPANY ELIMINATION -68,211. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,981,243. 1 ADIRONDACK HEALTH INSTITUTE INC 9 CAREY ROAD QUEENSBURY NY 12804 141698269 501(C)(3) 791809 THE GRANT WAS GIVEN FOR THE HEAL 10 PROGRAM. 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE GRANT WAS GIVEN TO AN ORGANIZATION THAT SHARES BOARD MEMBERS WITH HUDSON HEADWATERS HEALTH NETWORK. THE BOARD MEMBERS ARE ABLE TO MONITOR AND REPORT BACK TO HHHN'S BOARD THAT THE FUNDS ARE BEING USED PROPERLY. X X X 0 0 0 0 0 0 0 0 0 CHRISTOPHER TOURNIER 128830 0 45099 0 339 0 6705 0 17710 0 198683 0 0 0 DANIEL LARSON MD 201566 0 9597 0 4965 0 10647 0 18890 0 245665 0 0 0 EDWARD SHANNON 131401 0 48877 0 1028 0 7260 0 21401 0 209967 0 0 0 GEORGE PURDUE 148863 0 78129 0 660 0 9889 0 18755 0 256296 0 0 0 JOHN RUGGE 350503 0 125700 0 8697 0 13960 0 20308 0 519168 0 0 0 JOHN SAWYER 210359 0 8212 0 4519 0 10835 0 18274 0 252199 0 0 0 PAUL BACHMAN 206263 0 2057 0 4227 0 10363 0 18403 0 241313 0 0 0 BRIAN MCDERMOTT 300710 0 13134 0 0 0 13898 0 0 0 327742 0 0 0 DANIEL WAY 204104 0 2084 0 2742 0 9479 0 17484 0 235893 0 0 0 MICHAEL ADAMS 201128 0 2023 0 307 0 9438 0 17882 0 230778 0 0 0 TODD WALDORF 234552 0 2383 0 450 0 11588 0 18316 0 267289 0 0 0 WILLIAM BORGOS 208571 0 2113 0 194 0 10077 0 18289 0 239244 0 0 0 PRIMARY CARE DEVELOPMENT CORPORATION JOHN RUGGE IS ON THE BOARD OF DIRECTORS OF PCDC. 500000 BRIDGE LOAN 0 FORM 990, PART VI, SECTION B, LINE 11 AN INDEPENDENT ACCOUNTANT PREPARES THE FORM 990. AFTER PREPARATION A MEETING WILL BE SCHEDULED WITH THE BOARD OF DIRECTORS AND OFFICERS TO REVIEW THE COMPLETED 990 AT OUR CAREY ROAD FACILITY PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS ITS' CONFLICT OF INTEREST POLICY WITH AN ANNUAL UPDATE OF ALL INTEREST THAT COULD POTENTIALLY LEAD TO A CONFLICT OF INTEREST FOR ALL EMPLOYEES. IF A CONFLICT OF INTEREST POTENTIAL IS RECOGNIZED THE BOARD SHALL DETERMINE WHETHER A CONFLICT EXISTS AND WHETHER SUCH DIRECTOR SHOULD ABSTAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 WHEN A NEW KEY EMPLOYEE IS HIRED IN THE PAST YEAR, COMPENSATION WAS DETERMINED THROUGH COMPARISON OF SIMILAR POSITIONS WITHIN THE ORGANIZATION. WE ALSO SURVEY WHERE POSSIBLE, COMPARABLE POSITIONS WITHIN THE REGION. COMPENSATION IS DETERMINED BY A COMBINATION OF SENIOR MANAGEMENT, FINANCE AND HUMAN RESOURCES TO ENSURE FAIRNESS AND CONSISTENCY IN SETTING PAY RATE AND BENEFIT LEVELS. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON WRITTEN REQUEST. THEY WILL BE MADE AVAILABLE AT OUR ADMINISTRATIVE OFFICE AT 9 CAREY ROAD, QUEENSBURY, NY. FORM 990, PART XII, LINE 2C: THE SELECTION AND OVERSIGHT PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. FORM 990, PART IV, QUESTION 20A: THE ORGANIZATION IS LICENSED UNDER ARTICLE 28 OF NEW YORK STATE PUBLIC HEALTH LAW. HOWEVER, SUBSECTION 10 OF ARTICLE 28 EXCLUDES CERTAIN HEALTHCARE FACILITIES FROM THE DEFINITION OF GENERAL HOSPITAL. THEREFORE, THE ORGANIZATION IS NOT INCLUDING SCHEDULE H IN THE CURRENT YEAR FORM 990 AS THEY DO NOT MEET THIS DEFINITION. HUDSON HEADWATERS HEALTH FOUNDATION 9 CAREY RD QUEENSBURY NY 12804 651261242 FINANCIAL SUPPORT TO HUDSON HEADWATERS HEALTH NETWORK NY 501(C)(3) LINE 11A, I HUDSON HEADWATERS HEALTH NETWORK 0 COMPRE CARE INC 9 CAREY RD QUEENSBURY NY 12804 141692479 IDLE HEALTH CTR OPERATION NY 501(C)(3) LINE 3 HUDSON HEADWATERS HEALTH NETWORK 0 HUDSON HEADWATERS HEALTH MANAGEMENT PO BOX 357 GLEN FALLS NY 12801 141467175 NY C 596 113289 1.00000 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 1 0 0